MyMedR

Fulltext ‘Sub-superscan’ in bone scan – an important feature of extensive bone metastases

Khadijah Abdul Hamid, Mohammad Nazri Md Shah

Malaysian Journal of Medicine and Health Sciences, 2020;16(102):75-77.

MyJurnal

A Superscan is described as a ‘beautiful bone scan’. In a superscan, the uptake of 99mTc-Methelene Diphosphonate (MDP) is prominent in the skeleton relative to soft tissue with absent or faint visualisation of the kidneys. This finding could be misinterpreted as a normal bone scan. A ‘Sub-superscan’ is a term used for scan findings in which the up- take is atypical of a superscan, but the patient has extensive bone metastases, as presented in our case report.

Matched MeSH terms: Bone Neoplasms

a case with massive metastases to bone and soft tissues of arm

Lopez CG, Ganesan S, Dutt AK, Omar bin Din

Med J Malaya, 1969 Dec;24(2):154-7.

PMID: 4244143

Matched MeSH terms: Bone Neoplasms/etiology*

Fulltext Which is the best method of sterilization of tumour bone for reimplantation? A biomechanical and histopathological study

Singh VA, Nagalingam J, Saad M, Pailoor J

Biomed Eng Online, 2010;9:48.

PMID: 20831801 DOI: 10.1186/1475-925X-9-48

Sterilization and re-usage of tumour bone for reconstruction after tumour resection is now gaining popularity in the East. This recycle tumour bone needs to be sterilized in order to eradicate the tumour cells before re-implantation for limb salvage procedures. The effect of some of these treatments on the integrity and sterility of the bone after treatment has been published but there has yet been a direct comparison between the various methods of sterilization to determine the one method that gives the best tumour kill without compromising the bone's structural integrity.

Matched MeSH terms: Bone Neoplasms/pathology; Bone Neoplasms/surgery*

Unusual Bone Superscan, MIBG Superscan, and 68Ga DOTATATE PET/CT in Metastatic Pheochromocytoma

Tan TH, Wong TH, Hassan SZ, Lee BN

Clin Nucl Med, 2015 Nov;40(11):867-8.

PMID: 26252329 DOI: 10.1097/RLU.0000000000000920

A 17-year-old adolescent boy with biochemically raised 2-hour urinary metanephrine and normetanephrine as well as CT findings of retroperitoneal soft tissue mass and bony metastases was referred for further assessment. Apart from Ga DOTATATE PET/CT evaluation, pretargeted systemic radionuclide therapy assessment with I-MIBG scintigraphy showed unusual phenomenon of MIBG superscan. Postsurgically, restaging Tc-MDP bone scintigraphy showed typical bone superscan features. The MIBG superscan was better delineated on post-I-MIBG therapy images.

Matched MeSH terms: Bone Neoplasms/radionuclide imaging*; Bone Neoplasms/secondary

Fulltext Ultrasound-guided percutaneous trucut needle biopsy for musculoskeletal tumours

Sallehuddin, A., Saw, A., George, J., Sengupta, S.

Malays Orthop J, 2008;2(1):12-16.

MyJurnal

Purpose: To evaluate the usefulness of ultrasound guidance in percutaneous needle biopsy for musculoskeletal tumours.
Methods: Forty-five consecutive patients underwent ultrasound-guided needle biopsy. An additional group of 50 patients who underwent needle biopsy without ultrasound guidance was retrospectively selected as historical control. The sample was considered adequate when a diagnosis can be made, and diagnostic when the diagnosis is similar to the final report based on the excised tumour.
Results: Adequacy of the biopsy samples was 84% in ultrasound-guided group as compared 76% in the group with no ultrasound guidance. Diagnostic accuracy was 64% in the ultrasound-guided group and 52% in the group without ultrasound guidance. Both of these differences were not statistically significant.
Conclusions: Ultrasound guidance did not provide a significant advantage in the biopsy of musculoskeletal tumours. Diagnostic accuracy seems to improve with the use of larger 14 gauge biopsy needle but further evaluation is necessary.

Matched MeSH terms: Bone Neoplasms*

Tumour volume and lung metastasis in patients with osteosarcoma

Munajat I, Zulmi W, Norazman MZ, Wan Faisham WI

J Orthop Surg (Hong Kong), 2008 Aug;16(2):182-5.

PMID: 18725669

To assess the association between tumour volume and occurrence of lung metastasis in patients with osteosarcoma and to determine the cut-off value.

Matched MeSH terms: Bone Neoplasms/pathology*

Fulltext Tuberculosis of the skull mimicking a bony tumor

Rosli FJ, Haron R

Asian J Neurosurg, 2016 2 19;11(1):68.

PMID: 26889285 DOI: 10.4103/1793-5482.172594

We present a rare case of calvarial tuberculosis mimicking a solitary bone tumor, which was surgically removed. A 52-year-old female presented with a right forehead swelling, which gradually enlarged over the course of 2 years, with no symptoms or raised intracranial pressure or neurological deficits. Plain and contrast-enhanced brain computed tomography scans were done, revealing a punched-out lesion of the right frontal bone, with a nonenhancing lytic mass. With an initial diagnosis of an intraosseous meningioma, and later on intraoperatively thought to be a metastatic tumor, the mass was excised along with a rim of bone. Histopathological examination results came back as caseous necrosis, highly suggestive of tuberculosis. The patient was then treated with a 1 year regimen of anti-tuberculous medications. Tuberculosis of the cranium is a rare entity, and can mimic tumors or multiple myeloma. A high index of suspicion and knowledge is required for an early diagnosis. A combined surgical and medical therapy is curative.

Matched MeSH terms: Bone Neoplasms

Fulltext Tuberculosis of the distal end of the radius mimicking a giant-cell tumour

Pan KL, Ibrahim S

Med J Malaysia, 2000 Sep;55 Suppl C:105-6.

PMID: 11200036

We report a case of a lady presenting with a lesion in the distal radius with classical radiological features of a giant-cell tumour. These tumours are often resected without preliminary histological confirmation. A biopsy done in this patient showed it to be tuberculosis.

Matched MeSH terms: Bone Neoplasms/radiography*

Fulltext Transarticular spread of the sacroiliac joint in a chondrosarcoma

Chong VFH, Pathmanathan R, Sambandan SS

Med J Malaysia, 1994 Sep;49(3):282-4.

PMID: 7845280

Primary bone tumours, even in very advanced stages, rarely exhibit transarticular spread. We present a case of chondrosarcoma of the ilium with destruction of the sacroiliac joint, the ipsilateral sacral ala and with sacral nerve involvement.

Matched MeSH terms: Bone Neoplasms/pathology*; Bone Neoplasms/radiography

Fulltext Thoracoplasty with acrylic plate-marlex mesh combination following near total resection of sternum: a case of chondrosarcoma of sternum

Premnath N, Lo HL, Cheong YT, Manjit S

Med J Malaysia, 2002 Sep;57(3):368-70.

PMID: 12440279

Removal of the whole sternum for malignant tumours results in a large defect, causing severe deformity and possible paradoxical movements of the chest wall. The reconstruction of the resultant large defect of the chest wall is often complex and difficult. Commonly used materials include rib autograft, steel strus acrylic plate and various synthetic meshes such as Goretex or Marlex mesh, with a myocutaneous flap for coverage. A case of a 48-year-old man with sternal chondrosarcoma successfully treated with thoracoplasty using acrylic plate-marlex mesh combination following near total resection of sternum is reported.

Matched MeSH terms: Bone Neoplasms/surgery*

Fulltext The role of computed tomography in the evaluation of retinoblastoma

Sherazi ZA, Jayakumar CR

Singapore Med J, 1992 Oct;33(5):496-9.

PMID: 1455277

To assess the importance of Computed Tomography(CT) in the evaluation of retinoblastoma, we reviewed thirteen cases of retinoblastoma which presented at Hospital University Sains Malaysia, Kelantan, Malaysia, from August 1986 to June 1991. High resolution computed tomography of the orbits was performed in all patients prior to therapy. Nine patients (69%) had unilateral and four (31%) had bilateral retinoblastoma. The interesting features were the remarkably high incidence in the right eye (89%) as compared to the left eye (11%) in unilateral retinoblastoma, and overall predominance of the male population (male to female ratio was 2:1). Computed tomography detected intraocular calcification in 82% of the tumourous eyes. All patients presented at late stages when tumours were of large size. The presence of calcification was not related to the size of the tumour. CT detected calcification in a suspected retinoblastoma with a high degree of accuracy. Computed tomographic evidence of intraocular calcification in children under 3 years of age is highly suggestive of retinoblastoma.

Matched MeSH terms: Bone Neoplasms/secondary

The pathology of tumour and "tumour-like" lesions of bone in the University Hospital, Kuala Lumpur

Peh SC, Cheah PL, Sengupta S

Malays J Pathol, 1988 Aug;10:45-50.

PMID: 3252076

Matched MeSH terms: Bone Neoplasms/epidemiology; Bone Neoplasms/pathology*

Fulltext The current standing on the use of denosumab in giant cell tumour of the bone

Singh VA, Puri A

J Orthop Surg (Hong Kong), 2020 12 18;28(3):2309499020979750.

PMID: 33331233 DOI: 10.1177/2309499020979750

Giant cell tumour of the bone (GCTB) has been classically treated surgically. With the advent of denosumab, there is potential to use it as a targeted therapy to downstage the tumour and control its progression. Like all new therapies, the dosage, duration, and long-term effects of treatment can only be determined over the time through numerous trials and errors. The current recommendation of use of the monoclonal antibody is 3-4 months of neoadjuvant denosumab in patients with advanced GCTB for cases who were not candidates for primary curettage initially, and prolonged use for surgically unsalvageable GCTB. The use of Denosumab in the adjuvant setting to prevent recurrence is not established.

Matched MeSH terms: Bone Neoplasms/therapy*

Fulltext The Values of Receptor Activator Nuclear Kappa-B Ligand Expression in Stage III Giant Cell Tumor of the Bone

Ghani SA, Wan Ismail WF, Md Salleh MS, Yahaya S, Syahrul Fitri ZM

Indian J Orthop, 2018 2 9;52(1):31-34.

PMID: 29416167 DOI: 10.4103/ortho.IJOrtho_153_17

Background: Giant cell tumor (GCT) of bone is a benign locally aggressive primary bone tumor which is risky for local recurrences and pulmonary metastasis. Till date, there are still many uncertainties in predicting the aggressiveness of GCT. We aim to investigate whether receptor activator nuclear kappa-B ligand (RANKL) expression may determine the prognosis of the lesion.

Materials and Methods: We examined RANKL expression in 39 patients (21 males, 18 females) by immunohistochemistry. Four patients (10%) were presented with tumor recurrence, eight patients (20%) were complicated with lung metastasis, and two patients (5%) were presented with both recurrence and lung metastasis. Positive RANKL expression was assessed according to a scoring system evaluating the percentage of the immunostained epithelial area and the staining intensity. The cumulative score was calculated to determine the final score value. Data were analyzed using PASW version 18.0 and independent t-test between nonrecurrence/recurrence groups, and nonlung metastasis/lung metastasis groups. Significance was set at P < 0.05.

Results: Thirty-two patients (82%) scored 3 in RANKL-staining percentage from whole stromal cell population (>75%), 6 patients scored 2, and 1 patient scored 1. Nine patients (23%) scored 3 in RANKL-staining intensity (most intense), 19 patients (48%) scored 2, and 11 patients (29%) scored 1. Twenty six patients (67%) had strong RANKL expression (total score of 5-6), 12 patients (31%) showed moderate score (3-4) whereas only 1 patient (2%) showed weak RANKL expression. Together, the mean value of RANKL-staining percentage was 2.79, intensity 1.95 and the total score 4.77. The mean RANKL-staining percentage between recurrence and nonrecurrence groups was statistically significant (P = 0.009). There was no significant difference in the mean staining intensity and total score between nonrecurrence and recurrence groups, and staining percentage staining intensity and a total cumulative score of RANKL expression between lung metastasis and nonlung metastasis groups.

Conclusion: RANKL expression is generally high in Stage III GCT and is a reliable prognostic marker in predicting the risk of local recurrence however not in lung metastasis.

Matched MeSH terms: Bone Neoplasms

Fulltext The Incidence of Malignant Infiltration in the Biopsy Tract of Osteosarcoma

Mohana, R., Faisham, W.I., Zulmi, W., Nawfar, A.S., Effat, O., alzihan M.S.

Malays Orthop J, 2007;1(2):7-10.

MyJurnal

Biopsy is a crucial step in the management of musculoskeletal sarcoma. The surgical approach to the biopsy site is important, as the tract must be removed en bloc with the tumour during limb sparing surgery so as to reduce the risk of local recurrence. The biopsy tracts of 26 osteosarcoma patients were evaluated histologically for tumour infiltration. Horizontal sections of 1 mm thickness with 2 cm radius from were evaluated from each excised biopsy tract. Five out of 26 cases (19.2%) showed positive tumour infiltration. One case (3.85%) had tumour infiltration in the pseudocapsule, two cases (7.69%) had tumour infiltration into the muscle and two other cases (7.69%) had tumour infiltration into the subcutaneous tissue. None had skin infiltration. We conclude that resection of the entire biopsy tract is indeed mandatory for surgical treatment of osteosarcoma.

Matched MeSH terms: Bone Neoplasms

Fulltext Temporal bone carcinoma: a case report

Noorizan Y, Asma A

Med J Malaysia, 2010 Jun;65(2):162-4.

PMID: 23756808 MyJurnal

Temporal bone carcinoma may masquerade as an infective process causing late diagnosis. A delay in treatment as a result of missed diagnosis would carry a poor prognosis as the disease progresses to an advanced stage. We present a lady with history of chronic otorrhea, who developed left sided otalgia associated with hearing loss in her sixth decade. She underwent surgery which revealed left mastoiditis and cholesteatoma. After a year, she had a mass in her left ear and pus discharge which was initially treated as an infection. The biopsy of the mass was proven to be squamous cell carcinoma. High index of suspicion is necessary when encountering patients presenting with a mass in the ear canal with prior history of chronic otorrhea or cholesteatoma. Proper tissue biopsy is crucial. Early referral to tertiary centre is required for further management of the patient.

Matched MeSH terms: Bone Neoplasms

Fulltext Temporal Bone Chondroblastoma: a Rare Entity

Yusof ANM, Thong HK, Kamalden TMIT

Med Arch, 2020 Aug;74(4):312-314.

PMID: 33041452 DOI: 10.5455/medarh.2020.74.312-314

INTRODUCTION: Chondroblastoma is an uncommon benign, locally destructive tumor that usually arises from epiphyses of the long bones. Temporal bone chondroblastoma is an extremely rare occurrence. Chondroblastoma arise from immature cartilage cells and it may display certain malignant features by invading surrounding structures and metastasizing to adjacent sites.

AIM: To present a case of extradural temporal bone chondroblastoma and discuss the clinical presentation, radiographic findings, histology and particularly the surgical management of the case.

CASE REPORT: We report a case of a 31-year-old man who presented with a painless left temporal swelling and left sided hearing loss for four months. Computed tomography (CT) scan revealed an aggressive mass involving the left preauricular region with temporal mastoid bone erosion. Magnetic resonance imaging (MRI) showed an extra-axial left temporal mastoid mass pushing the left temporal lobe superiorly. The patient underwent complete excision of the temporal bone tumor. The final histopathological diagnosis was in keeping with chondroblastoma.

CONCLUSION: Temporal bone chondroblastoma is rare but an aggressive condition. Complete tumor resection via an appropriate approach that enables adequate exposure will lead to a favorable outcome.

Matched MeSH terms: Bone Neoplasms/diagnosis*

Fulltext Survival analysis of osteosarcoma patients: A 15-year experience

Yasin NF, Abdul Rashid ML, Ajit Singh V

J Orthop Surg (Hong Kong), 2020 2 23;28(1):2309499019896662.

PMID: 32077796 DOI: 10.1177/2309499019896662

INTRODUCTION: Management of osteosarcoma has evolved considerably for the past two decades and there have been changes of practices especially pertaining to chemotherapy regime. This is a review of our cases in the past 15 years.

METHOD: This is a retrospective survival analysis study of 128 patients treated at University Malaya Medical Centre (UMMC) from 1997 to 2011.

RESULTS: There were 80 (62.5%) male and 48 (37.5%) female patients with the median age being 15 (5-59). Majority had osteosarcoma of extremities (94.5%). More than 60% patients developed metastasis throughout the course of treatment with 39% presenting with lung metastasis. Osteoblastic osteosarcoma was the commonest subtype (65.6%). Of the 109 patients treated surgically, 84 patients (65.6%) underwent limb salvage surgery while the rest underwent amputation. Seventy-one per cent of patients completed treatment with local recurrence rate of 22.7%. The 5-year and 10-year survival rates were 56.31% (95% CI: 46.20, 65.24) and 22.33% (95% CI: 14.86, 30.76), respectively. The 5-year event-free survival was 52.94% (95% CI: 41.83, 62.87). In multivariate analysis, the independent prognostic factors were presence of metastasis and completion of treatment for both 5-year and 10-year overall survival. Good histological response was only significant for multivariate analysis at 5 years. Patients with metastasis had a hazard ratio of 20.4 at 5 years and 3.26 at 10 years.

CONCLUSION: Overall survival rate for osteosarcoma patients at our centre was comparably higher than other centres in the region. Two independent risk factors for survival are metastatic status and completion of treatment. A standardized chemotherapy regime is essential for long-term survival.

Matched MeSH terms: Bone Neoplasms/mortality*; Bone Neoplasms/surgery

Fulltext Squamous cell carcinoma involving the tibia treated by reimplantation of autoclaved resected bone

Pan KL, Mourougayah V, Jayamalar T

Med J Malaysia, 2003 Dec;58(5):783-5.

PMID: 15190672

We present an elderly patient with a squamous cell carcinoma over the subcutaneous aspect of the leg involving the tibia. En bloc resection of the tumour together with a 10 centimetre segment of the tibia was done. The resected bone was autoclaved, replaced in its original position and stabilized with bone cement and a locked nail. This allowed early ambulation with minimal cost.

Matched MeSH terms: Bone Neoplasms/surgery*

Fulltext Spontaneous Conventional Osteosarcoma Transformation of a Chondroblastoma: A Case Report and Literature Review

Narhari P, Haseeb A, Lee S, Singh VA

Indian J Orthop, 2018 2 9;52(1):87-90.

PMID: 29416176 DOI: 10.4103/ortho.IJOrtho_495_17

Chondroblastomas are a primary benign cartilaginous tumor that accounts for approximately 1% of all benign bone tumors. Primarily they are treated by curettage. The patient presented 4 years after a successfully treated chondroblastoma (curettage and Bone cement). Wide resection of the proximal tibia with endoprosthesis replacement was done. Lung CT showed multiple lung metastasis and despite starting chemotherapy, he succumbed to the disease. We discuss regarding the possibilities of "aggressive" chondroblastoma and more recently termed chondroblastoma-like osteosarcoma which is a separate entity from chondroblastoma. Aggressiveness in chondroblastoma can be 1 of 3 types as follows: 1. benign chondroblastoma with lung metastasis. 2. malignant chondroblastoma. 3. subsequent malignant transformation of benign chondroblastoma. We have attempted to review the literature and describe the "aggressive" chondroblastoma and chondroblastoma-like osteosarcoma in this report.

Matched MeSH terms: Bone Neoplasms

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